Universitas Mahasaraswati Denpasar

Schefflera elliptica leaves contain secondary metabolites such as flavonoids, tannins, and saponins that have the potential as antibiofilm agents. Biofilms produced by Staphylococcus aureus are often the cause of chronic infections, especially on wounds and medical devices such as catheters. Antibiofilm activity of plant extracts is promising as an adjuvant or alternative therapy. The purpose of this study was to determine the antibiofilm activity of ethyl acetate extract of S. elliptica leaf against clinical isolates of S. aureus. This study is an analytical study with a laboratory experimental design to determine antibiofilm activity. The research samples were 18 clinical isolates of S. aureus obtained from patients undergoing examination at the hospital from June 2022 to December 2022. The research was carried out using the stages of sample preparation, extract preparation, biofilm assay with microtiter plate, and antimicrobial test with disc diffusion test method. The results of this study showed that the extract of S. elliptica leaf was able to reduce the average biofilm formation by clinical isolates of S. aureus significantly (p<0.001), both at doses of 10 µL (reduced by 12%) and 20 µL (reduced by 56.7%). Despite having antibiofilm activity, a disc diffusion test with a dose of 20 ul extract of S. elliptica leaf showed no or minimal antimicrobial activity against clinical isolates of S. aureus. Overall, the results of this study indicate that the extract of S. elliptica leaf has the potential as an antibiofilm agent against S. aureus. The results of this study are expected to be the basis of further research for the development of antibiofilm from natural materials.

Work-life balance is crucial in fostering a sense of ownership and achieving company success. When employees can achieve a good balance between work and personal lives, they are more satisfied and have higher organizational commitment. This study aims to determine the mediation role of organizational commitment and job satisfaction in the effect of work work-life balance on employee performance targeting five-star hotels in Bali, Indonesia. This quantitative analysis surveyed 157 employees using purposive sampling. The data analysis is done via a partial least squares approach. The results show that organizational commitment mediates the influence of work-life balance on employee performance. This is indicated by the t-statistic coefficient of 1.972 > t-table 1.96, and the significance value is 0.049 < 0.05. Job satisfaction mediates the effect of work-life balance on employee performance with a t-statistic value of 3.291 > t-table 1.96 and a significance value of 0.001 < 0.05. It means job satisfaction mediates the influence of work-life balance on employee performance. This paper implies that the model can be used to develop policies that encourage work-life balance. For instance, ensuring a balanced workload among team members can prevent fatigue and provide employees with sufficient time for rest and leisure activities. Additionally, implementing family support programs can enhance organizational commitment, job satisfaction, and performance.

Triple-negative breast cancer is an aggressive and poor prognosis subtype of breast cancer. Eribulin has shown promise in the treatment of metastatic triple-negative breast cancer (mTNBC). This review aimed to provide a specific description, evidence, and discussion of the efficacy and safety of eribulin both as monotherapy and in combination with another agent in patients with mTNBC. The search was conducted in five databases (PubMed, ScienceDirect, PLoS One, Wiley Online Library, and Cochrane Library) towards published articles during the 2013-2023 period. A total of 237 articles were identified. After removing 69 duplicates, 168 articles underwent the screening process and 10 articles met the research criteria. Eribulin monotherapy effectiveness profile includes: overall survival (10.8-17.6 months), progression-free survival (2.8-3.2 months), partial response (21.0%-58.7%), progressive disease (15.5% -47.0%), and stable disease (28.8%-32%). However, there were no cases of complete response. Combination of eribulin with other agents' effectiveness profiles includes: overall survival (8.3-14.5 months), PFS (2.6-8.1 months), partial response (31.8-76.0%), complete response (2.4-8%), progressive disease (8.0-28%), and stable disease (8.0-52.3%). Eribulin monotherapy's safety profile is similar to that of combination therapy. No grade 5 adverse event was reported during monotherapy or in combination with other agents. The grade 4 adverse events reported are neutropenia, leukopenia, thrombocytopenia, anemia, peripheral neuropathy, fatigue, diarrhea, vomiting, dyspnea, back pain, arthralgia, febrile neutropenia, dyspnea, constipation, general physical health deterioration, alopecia. The all-grade adverse events with a percentage above 50% are neutropenia, leukopenia, thrombocytopenia, asthenia, alopecia, elevated AST, elevated ALT, hand-foot syndrome, fatigue, anemia, peripheral neuropathy, oral mucositis, and nausea.

Background Bali, one of the world's most popular tourist destinations, is hyper‐endemic to dengue, an acute febrile illness caused by infection with dengue virus (DENV). Outbreaks of dengue occur annually with worrisome rates of morbidity and mortality. Despite this, comprehensive and continuous virus surveillance is yet to be established. We conducted DENV serotype and genotype surveillance in Bali to monitor viral transmission dynamics. Methods We enrolled febrile patients with dengue clinical symptoms in hospitals in Denpasar, Bali. Clinical evaluations and laboratory assessments were conducted, and blood samples were collected. DENV serotypes were determined using RT‐PCR, and genotyping was performed by sequencing the envelope protein gene and the complete genomes. Subsequently, phylogenetic analyses were conducted to analyse the recent data alongside retrospective sequence data. Results A total of 62 and 66 dengue patients were recruited during 2018–2020 and 2022, and from these, we obtained DENV serotype data for 49 and 48 individuals, respectively. Among the DENV analysed, the most prevalent serotype in 2018–2020 was DENV‐1 (30%) and shifted to DENV‐3 (57.6%) in 2022. When compared to data from the last 10 years, serotype shifting was clearly observed. We sequenced the genomes of 60 isolates and observed the presence of multiple virus lineages and the replacement of Genotype IV of DENV‐1 with Genotype I. The Cosmopolitan, Genotype I and Genotype II remained the predominant genotypes for DENV‐2, DENV‐3 and DENV‐4, respectively. Conclusion We reveal that DENV serotype predominance in Bali has been shifting in the past 10 years. While genotype replacement occurred, continuous circulation of local endemic viruses was responsible for the annual outbreak of dengue. These findings indicate the genetic diversity and dynamic nature of DENV circulating in Bali. Routine virus surveillance is important to understand the cyclical patterns of DENV serotypes that is useful to predict the future outbreaks.

Agroforestry has been widely suggested as a tool for storing carbon while also providing other ecosystem services like food and income production. A greater understanding of how carbon storage in agroforestry systems varies, and particularly how it is intertwined with the productivity of these systems, could enable farmers and policymakers to make changes that simultaneously increase carbon storage and alleviate poverty. In this study, we used allometric equations to evaluate the carbon storage in the biomass of two complex agroforestry systems in Bali, Indonesia—rustic where a native tree canopy is still present, and polyculture where all native trees have been removed, and the canopy consists only of cropping trees. We then compared these figures to that of a nearby primary forest and linked carbon storage to productivity for both agroforestry systems. We found that the primary forest (277.96 ± 149.05 Mg C ha⁻¹) stored significantly more carbon than either the rustic (144.72 ± 188.14 Mg C ha⁻¹) or polyculture (105.12 ± 48.65 Mg C ha⁻¹) agroforestry systems, which were not significantly different from each other. We found productivity and carbon storage to be significantly positively correlated with each other within the polyculture system but not within the rustic system. We also found that for the rustic system, an increase in the density of native trees is accompanied by an increase in carbon storage, but no significant change in productivity. Consequently, we conclude that within the rustic system, carbon storage can be increased or maintained at a high value by the preservation and encouragement of large native trees, and that this need not necessarily result in a decrease in productivity.

Introduction: The incidence rate of newly diagnosed HIV infection in Indonesia decreased from 21 per 100,000 in 2011 to 10 per 100,000 in 2021. Despite this progress, AIDS-related deaths among people living with HIV (PLWH) increased from 3.4% in 2010 to 4.8% in 2020. Determining risk factors for mortality may identify areas to intervene and reduce mortality. Methods: A multicenter, prospective, observational cohort study of HIV infection, coinfections, and comorbidities (INA-PROACTIVE) was carried out at 19 hospitals across major islands in Indonesia. The study enrolled PLWH from 2018-2020 and followed them for 3 years. For this analysis, PLWH ≥ 18 years old with one year of follow-up data were included. Cox regression was used to identify variables at enrollment that correlated with one-year mortality. Results: Among the 4,050 PLWH analysed in the study, 68.8% were male, 53.5% acquired HIV through heterosexual transmission, 92.4% were on antiretroviral treatment (ART) at enrollment, and 72.4% had an undetectable viral load. At one year, 115 (2.8%) had died. Detectable viremia at enrollment was significantly associated with mortality, with the risk increasing as the viral load (VL) category increased (adjusted hazard ratio [aHR] 4.47, 95% CI: 1.47-13.56 for VL 50 to < 1,000 copies/mL; aHR 7.88, 95% CI: 2.80-22.20 for VL 1,000 to 10,000 copies/mL; and aHR 18.33, 95% CI: 7.94-42.34 for VL > 10,000 copies/mL; compared to VL < 50 copies/mL). Other factors at enrollment significantly associated with mortality were a CD4 + count < 200 (aHR 8.02, 95% CI: 2.69-23.86; compared to ≥ 350), age 40-49 years (aHR 2.19, 95% CI 1.23-3.87; compared to 18-29 years) and being underweight (aHR 1.84, 95% CI: 1.18-2.85; compared to normal weight). Conclusions: Among predominantly treatment-experienced PLWH, detectable viremia and continued immunosuppression were significantly associated with one-year mortality. This study highlights the importance of ART with complete viral suppression as well as immune recovery to prevent mortality. Trial registration: Clinical Trial Number: NCT03663920, registration date: 4 January 2018.

Ecotourism long has been regarded as a model of tourism development that fosters businesses, empowers local communities, and benefits for nature conservation. While many studies emphasize its environmentally friendly attributes, few have explored its relationship with capitalism and indigenous people. This article examines the local-global dynamics of an indigenous community in Bali, Indonesia, focusing an old-Balinese village, Tenganan Pegringsingan, and its engagement with Village Ecotourism Network (JED) project. We deployed an ethnographic discourse analysis as research methods with observation participation, interview, and discourse analysis. We challenge the assumption that global ecotourism effectively supports the economic and cultural sustainability of local populations. Our findings reveal that ecotourism has reinforced the economic interests of villagers by facilitating the spread of capitalist ideas in the development of tourist village. Instead of enhancing livelihoods, ecotourism encourages increased consumption and necessitates a re-evaluation of capital resources within the tourism sector, it has marginalized many individuals who lack resources and capital. Moreover, we suggest that the ecotourism extends beyond the confines of the economic, cultural, and conservation, an important discourse underlying this is the interplay between the shift of consumption and the idea of managing the capital, which subtly illuminates another aspect of indigenous communities.

Ischemic stroke (IS) is the most recorded case of stroke that is caused by decreased blood flow to the brain. Nowadays, therapeutical agents for IS are limited and they have not shown maximum clinical results. Therefore, the exploration of new candidates for IS treatment continues to be done. Zebrafish as one of the animal models has its advantages and currently is being developed to be incorporated into the drug discovery pipeline of IS. This review explores the latest applications of the zebrafish model in screening potential therapeutic agents for IS. Key factors related to the experimental design such as developmental stage and strain, routes of drug administration, induction methods, and experimental parameters are also elaborated. Finally, this review offers future recommendations for the use of zebrafish in the pre-clinical study of IS. This review is beneficial as a reference for establishing drug screening protocols using the zebrafish IS model.

Noise is an environmental condition that we encounter in everyday life. The level of noise varies in certain environments, such as work environments, traffic on highways, noise in cafeterias, and others. This exposure can affect the coordination system in our body, such as the cerebellum. Soursop leaf extract has been widely used in traditional medicine, the antioxidant content in this extract has many health benefits. Soursop leaf extract (Annona muricata L.) can be useful as an anti-inflammatory, providing protection to nerve cells from free radicals, and other benefits. This study aims to test the effect of soursop leaf extract on neurons in the cerebellum layer. The study was conducted at the experimental animal stage. The experimental animals used were adult Wistar rats which were divided into 2 control groups and 1 treatment group. Each group consisted of 15 Wistar rats. The treatment group was given ethanol extract of soursop leaves before being exposed to noise. The results showed that there were significant differences in the density of molecular layer nerve fibers, between K- and K+ groups (p=0.000) and P (p=0.015), between K+ and P groups (p=0.015). There was a significant difference in Purkinje cell degeneration in the control and treatment groups, between K- and K+ groups (p=0.000) and P (p=0.003), between K+ and P groups (p=0.015). There was no significant difference in granular cell degeneration in the control and treatment groups, between K- and K+ groups (p=0.061) and P (p=0.838), between K+ and P (p=0.094), but the degeneration was lighter in P than K+. The conclusion of this study is that soursop leaf extract provides protection to neurons in the cerebellum from noise exposure.

The audit committee (AC) plays a crucial role in corporate governance, particularly in financial reporting and the selection of independent auditors. Despite this, the literature on the role of the AC chair is sparse. This study seeks to elucidate the influence of AC chairman characteristics on auditor selection. The AC chairman’s characteristics are proxied by expertise, tenure, gender, and nationality. Additionally, it broadens the scope of existing literature by categorizing accounting firms into three groups: first-tier, second-tier, and third-tier, as opposed to the traditional dichotomy of Big Four and non-Big Four. The research focuses on manufacturing companies on the Indonesia Stock Exchange from 2017 to 2022. Findings indicate that AC chairs with financial or accounting expertise are more likely to engage first-tier and second-tier accounting firms as independent auditors. In contrast, statistical analysis shows that the tenure of the AC chairman does not significantly impact the choice between first-tier and second-tier auditors. Furthermore, female and foreign AC chairs display a preference for hiring first-tier and second-tier firms over third-tier ones.

Parkinson's disease (PD) is a disorder of brain function that is pathologically characterized by degeneration of nerve cells in the brain, specifically the basal ganglia. Additionally, there is a loss of pigmentation in the substantia nigra, the presence of cytoplasmic inclusions called Lewy bodies, and a decrease in dopamine in the Substantia nigra Pars Compacta (SNC) and corpus striatum. Vitamin D may provide neuroprotection through the action of neurotrophic factors, which regulate neuronal growth, or through protection against cytotoxicity. In some studies, the synthesis of neurotrophic factors, including Neurotrophin 3 (NT3) and Glial Cell Line-derived Neurotrophic Factor (GDNF), was found to be upregulated by 1,25(OH)2D3. A number of studies have demonstrated a higher prevalence of vitamin D deficiency in individuals with Parkinson's disease (PD) compared to healthy controls. Following the discovery that Vitamin D Receptor (VDR) and 1α-hydroxylase, an enzyme responsible for converting vitamin D into its active form, are highly expressed in the substantia nigra, it was postulated that insufficient circulating vitamin D may contribute to the dysfunction or cell death observed in this region. Keywords: Parkinson Disease, Substantia Nigra Pars Compacta, Glial Cell Line-derived Neurotrophic Factor, Vitamin D Receptor

This paper presents the first attempt at establishing the dynamics of the Šumljak debris slide by using a multidisciplinary approach, including long-term inclinometer and piezometer measurements and a time-series analysis of SAR images for displacement vector estimation. The Šumljak landslide is located in the Rebrnice area, SW Slovenia, where the regional highway Razdrto-Nova Gorica runs through and poses a threat to the highway viaduct’s stability. By combining both ascending and descending Sentinel-1 data, we have estimated 3D displacement vectors for the landslide, providing insights into the usability of the technique for this kind of slow-moving landslides. Furthermore, we have combined and compared the SBAS DInSAR results to the displacements measured by inclinometer to evaluate the rate of displacement of the landslide and the viaduct. The inclinometer measurement results show that the landslide has a single sliding plane between the flysch colluvium and the slope deposits and provide the proof of the enlargement of the sliding area above its main scarp. The displacement vectors are spatially heterogenous, suggesting that different sites have different velocities and slightly different directional vectors. These results partly comply with the InSAR results. We further discussed the estimated vectors of displacement and the possible mechanism of movements. By using the piezometric data, we studied the groundwater level fluctuation in relation to daily rainfall and its influence on the displacements. Our findings show a correlation between the movements and the wet/dry season, indicating that the landslide is driven by rainfall and consequently groundwater level fluctuation. In 2020, the groundwater level rise was smaller than in the years before due to less rainfall, resulting in lower velocity of the landslide (5.5 mm/year) than in 2019 (7 mm/year).

Background: The co-occurrence of frailty, sarcopenia and malnutrition has been well studied in inpatient and nursing home settings, which are associated with a higher risk of all-cause mortality. However, multicentre data from community-dwelling outpatient settings are lacking. Therefore, we aimed to find the prevalence of frailty, possible sarcopenia and malnutrition, their overlap, and the associated factors in community-dwelling older outpatients. Methods: We collected data from community-dwelling outpatients aged 60 years in Indonesian geriatric care centres to conduct this cross-sectional study with bivariate and multivariable analyses. Frailty, possible sarcopenia and malnutrition diagnoses were based on the FRAIL scale, AWGS 2019 consensus and MNA-SF, respectively. Results: The prevalence of frailty, possible sarcopenia and malnutrition in community-dwelling older outpatients was 13.6%, 45.5% and 5.3%, respectively, while the prevalence of their co-occurrence was 3.3%. The prevalence was associated with transient ischaemic attack (TIA) and cerebrovascular accident (OR, 5.53; 95% CI: 1.48-20.61), cognitive impairment (OR, 3.70; 95% CI: 1.21-11.31), and dependent functional capacity (OR, 11.62; 95% CI: 3.38-39.99). The three evaluated syndromes were found to overlap in 24.1%, 7.2% and 61.3% of subjects with frailty, possible sarcopenia and malnutrition, respectively. Of these subjects, a substantial proportion were female or had low educational attainment, diabetes mellitus, hypertension, cognitive impairment, multimorbidity or dependent functional status. Conclusion: Approximately 1 in 30 community-dwelling older outpatients had overlapping frailty, possible sarcopenia and malnutrition. The condition is associated with TIA and cerebrovascular accident, cognitive impairment and dependent functional capacity. Standardized screening in community-dwelling older population is necessary.

Poisonous birds are rare but on New Guinea, including Indonesia’s easternmost provinces, no less than nine poisonous species, eight pitohuis and one species of ifrita, are found. Pitohuis when handled can cause sneezing with numbness and burning of nasal tissue and nausea in humans. In the bird markets of western Indonesia novelty birds are traded at a premium and overexploitation of popular songbirds leads traders to find replacement species to meet demand. We conducted over 800 surveys in the bird markets of Sumatra, Java, Bali, Lombok, and Sulawesi between 1994 and 2023 and from 2015 onwards we assessed the online trade in pitohuis and Blue-capped Ifrit Ifrita kowaldi. We identified the species, recorded their prices and location, and the date when the birds were offered for sale. We analysed temporal trends, volumes, prices, and geographical origin of the sellers. Between 1994 and 2014 we did not encounter a single pitohui in the Indonesian bird markets. In the following years we recorded 113 pitohuis in 12 bird markets and we recorded 199 pitohuis for sale online; 248 were variable pitohuis and 54 were Hooded Pitohui Pitohui dichrous. No ifritas were recorded. Most pitohuis were recorded in eastern Java and Bali. Prices differed between eastern Java (mean of US$93) and western Java and Bali (US$185), possibly suggesting pitohuis arrive from West Papua in eastern Java and from there make their way to the outer markets. Pitohuis are marketed as “Papuan Straw-headed Bulbuls”; the Straw-headed Bulbul Pycnonotus zeylanicus is a very popular and expensive songbird from Southeast Asia, including western Indonesia, that has become rare both in the wild and in the markets due to overexploitation. Discussions about pitohuis on online forums rarely mention “poisonous” but when it is mentioned traders dismiss this as something not to worry about and they claim it to be dietary-dependent. Poisonous pitohuis are novelty, as well as master, birds in Indonesia, where they are marketed for their song ignoring any negative side-effects of them being poisonous. The trade in novelty species, when detected early, does allow for the authorities to intervene in a timely manner to ensure that this trade does not impede their conservation.

Small and medium enterprises (SMEs) significantly contribute to society’s growth and welfare. Nevertheless, SMEs often experience challenges, i.e., high levels of competition and market demands. To maintain SMEs’ existence, a competitive advantage is demanded by increasing innovative work behavior. This study explores and evaluates the relationship between transformational leadership and innovative work behavior and examines the mediating role of knowledge sharing and psychological empowerment on the relationship between transformational leadership and innovative work behavior. This study uses a quantitative approach, where data were gathered from a questionnaire distributed to 190 employees of export SMEs and were further examined using Smart PLS 3.2.9. The findings demonstrate that transformational leadership does not influence innovative work behavior but significantly and positively influences psychological empowerment and knowledge sharing. Psychological empowerment and knowledge sharing significantly and positively influence innovative work behavior. Subsequently, psychological empowerment and knowledge sharing partially mediate the linkage between transformational leadership and innovative work behavior.

Several previous studies have demonstrated the benefits of early macrophage 2 activation fat grafts supplemented with macrophage culture. However, this approach is considered impractical in clinical settings because of intraperitoneal induction use. The aim of this study was to investigate the effect of early stromal vascular fraction (SVF) macrophage-2 activation with IL-4 on fat graft survival compared to SVF alone using an animal model for better fat graft viability. This experimental study included inguinal fat harvesting, isolated with collagenases to retrieve the SVF, and then injected with a combination of fat graft and SVF (0.3 mL) into the scalp region. The intervention group received an IL-4 intralesional injection on the third day, and the fat grafts were biopsied on days 7, 14, and 30. The primary outcomes were the final volume of the fat graft, vascular endothelial growth factor (VEGF) expression, and the adipocyte cell count using perilipin staining on immunohistochemistry examination. The group receiving IL-4 exhibited significantly higher VEGF on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Similarly, the IL-4 treatment significantly increased the perilipin concentration on days 7, 14, and 30 (p=0.008, 0.008, and 0.029, respectively). In this group, VEGF concentration was significantly increased on day 14 as compared to day 7 (p=0.009), while no significant difference was observed in the control group (p=0.090). Additionally, the IL-4 group displayed significantly less reduction of fat graft volume than the control group, as observed on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Overall, the study underscores the potential benefits of early M2 polarization in fat grafting, as well as providing practical advantages for improving fat graft volume retention.

Background Transarterial embolization (TAE) is pivotal in managing non-cavernous and cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Systematic searches were conducted across ScienceDirect, Medline, and Cochrane databases for longitudinal studies on TAE outcomes in non-CSDAVFs and CSDAVFs. Post-procedural outcomes, including complete, incomplete, and failed AVFs obliteration, and end-study outcomes were analyzed. Results Our meta-analysis involved 27 studies with 643 patients and 736 fistulas. Symptoms in both groups included tinnitus (29.74%), ocular/visual symptoms (29.12%), hemorrhage (19.42%), and headache (19.11%). Feeding arteries mainly originated from the meningeal arteries (49.16%). In non-CSDAVFs cases, fistula locations were within sinus complexes (69.23%) and specific dural areas (28.31%). Complete AVFs obliteration was 81% (95%CI: 70% - 90%), slightly higher in non-CSDAVFs (82%, 95% CI: 69% – 92%) than CSDAVFs (79%, 95%CI: 58% - 95%). Incomplete obliteration occurred in 14% (95%CI: 5% - 39%), with rates of 11% (95%CI: 2% - 26%) in non-CSDAVFs and 19% (95% CI: 5% - 39%) in CSDAVFs. Failed obliteration was rare (1%, 95%CI: 0% - 3%), with similar rates in both groups. At end-study follow-up, resolution of AVFs was achieved in 97% of cases (95%CI: 92% - 100%). However, complications occurred in 17% of cases (95%CI: 10% - 25%), with a higher incidence in CSDAVFs (22%, 95%CI: 9% - 37%) compared to non-CSDAVFs (13%, 95%CI: 6% - 23%). Conclusions TAE with embolic agents demonstrates favorable outcomes in non-CSDAVFs and CSDAVFs, with high rates of AVFs obliteration and resolution. Complications, particularly in CSDAVFs, warrant careful consideration in treatment decisions.

Introduction Renal leiomyoma is a rare renal tumor that originates from smooth muscle. Among all existing benign renal tumors, leiomyoma is one of the least common benign renal tumors. Case presentation We report of a case report of a 43-year-old male complaints of palpable mass on the upper left abdomen, abdominal discomfort and hematuria. Contrast-enhanced CT scan revealed a solid heterogenous mass on the left kidney, adherent to the left abdominal wall and pushed the spleen cranially. Patient underwent radical nephrectomy and histopathology results revealed leiomyoma. Two weeks after surgery, the patient was asymptomatic. Discussion Imaging of renal leiomyoma may provide a clue with a general finding of a well-defined tumor margin and no local invasion. In our case preoperative CT findings made the initial diagnosis inconclusive since it showed the renal mass was adherent to the abdominal wall. Definitive diagnosis was only possible through histopathologic examination. Conclusion Radical nephrectomy remains as the mainstay of treatment in inconclusive preoperative diagnosis.